臨牀消化器内科 Vol.13 No.11(5)


特集名 知っておくべき疾患 --胆・膵
題名 黄色肉芽腫性胆嚢炎
発刊年月 1998年 10月
著者 岩崎 誠 岩崎病院外科
著者 川原田 嘉文 三重大学医学部第一内科
【 要旨 】 黄色肉芽腫性胆嚢炎(XGC)は胆汁が胆嚢壁内に侵入し,黄色色素を含むxanthoma cellを主体とした肉芽腫性炎症をきたすまれな疾患である.その特徴として胆嚢壁の不整な肥厚と肝など周辺臓器にまで炎症性浸潤を伴って進展し,また病期や炎症の程度によって画像所見が異なることもあり,臨床的にとくに胆嚢癌との鑑別診断が問題となる.さらに術中所見からも胆嚢癌を否定できずにover surgeryとなることがあり,必ず術中迅速病理診断を行うことが大切である.また胆石症に比べ胆嚢癌の合併率が高く,しかも術後に胆嚢癌が発見されることもあり,術前あるいは術中にXGCと診断されても術中および術後の詳細な組織学的検索が必要である.
Theme Digestive Diseases to Know -- Biliary Tract, Pancreas
Title Xanthogranulomatous Cholecystitis
Author Makoto Iwasaki Depariment of Surgery, Iwasaki Hospital
Author Yoshifumi Kawarada First Department of Surgery, Mie University School of Medicine
[ Summary ] Xanthogranulomatous cholecystitis (XGO) is a rare disease in which bile enters the gallbladder wall resulting in the development of a granulomatous inflammation, mainly consisting of xanthoma cells containing bile pigments. XGC is characterized by irregular thickening of the gallbladder wall with extension of the infiammation into surrounding structures, particularly the liver. Imaging findings may differ depending on the stage and degree of inflammation. Thus, the differential diagnosis of XGC from gallbladder cancer is very difficult. However, gallbladder cancer cannot be ruled out on the basis of the intraoperative findings, and the result may be excessive surgery. Therefore, the intraoperative diagnosis should be based on frozen section histology. Galllbladder cancer is more strongly associated with XGC than it is with cholelithiasis, and the frequency of postoperative detection of gallbladder cancer in XGC is high. Therefore, detailed intraoperative and postoperative histological exploration is necessary, even when a diagnosis of XGC has made preoperatively or during an operation.
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